Application fee required at time of submission.
Non-refundable application payment via cash check or money order of $10.00 for a single discipline
project or $100.00 for a multi-discipline project is due at time of submission. Permits will not be
processed without the application fee. There may be additional fees required by the Township for
alteration of land or escrow fees you will be notified as those fees are assessed. Permit fees will be
invoiced by Code Inspections.
Plans on paper will not be accepted if they are
larger than 11x17”.
We conduct our reviews in a digital format and require signed sealed plans to be submitted in pdf format
emailed to permitcenter@bensalempa.gov or on a disk or thumb drive. We have the capability to scan
11x17” plans, if your plans are legible at this size we will accept them on paper. If you have any
questions about how to submit digitally, please call Tracey 215-633-3640. Submit only one complete set
of plans.
Any new plumbing fixtures require approval
from BCWSA.
Permits will not be issued without this approval. Exact Replacement or relocation of existing plumbing
fixtures do not need this approval. Verify plumbing section of the application has been completely filled
out and indicates if any fixtures are new. (EXAMPLE if there is an existing single sink being turned
into a double sink, approval from BCWSA is required). Email requests to engineering@bcwsa.net
Alteration of Land permits required.
Bensalem Township requires an alteration of land permit submitted with the building application for any
exterior work or change of grading.
BENSALEM TOWNSHIP
Building and Planning Department
Office 215-633-3644
Fax 215-633-3753
Matthew K. Takita
Director of Building and Planning
2400 Byberry Road Bensalem, PA 19020
Code Inspections,
Inc.
CONSTRUCTION PERMIT APPLICATION
605 Horsham Rd Horsham PA 19044 Office 215-672-9400 Fax 215-672-9736
Note: Read page four (4) in its entirety prior to completing this
application
LOCATION OF PROPOSED WORK OR IMPROVEMENT
Site Address: Tax Parcel #
Lot
#
Subdivision/Land
Development:
Phase:
Section:
TYPE OF WORK OR IMPROVEMENT (Check One)
New Building Addition Alteration Repair Demolition Relocation
Foundation Only Change of Use Plumbing Mechanical Electrical Other
Describe
the
proposed
work:
OWNER: Phone # Fax #
Mailing Address: Email:
CONTRACTOR INFORMATION
License # Name Address Phone#
Applicant
Carpentry
Concrete
Design Professional
Drywall or Lathing
Electrical
Excavation
Fire Alarm
Masonry
Mechanical
Paving
Plumbing
Principal Contractor
Roofing
Sewer
Sprinkler
TOTAL
ESTIMATED
COST
OF
CONSTRUCTION
(reasonable
fair
market
value)
$
DESCRIPTION OF BUILDING USE (Check One)
RESIDENTIAL
One Family Dwelling (R-3) Two Family Dwelling (R-3)
NON-RESIDENTIAL
Specific Use:
Change in Use: YES NO
Use Group:
If YES, Indicate
Former:
________________________
Maximum Occupancy Load:
Maximum
Live
Load:
BT 3 /2016 Page 1 of 4
ALL APPLICATIONS ARE TO BE SUBMITTED TO THE BENSALEM TOWNSHIP BUILDING & PLANNING DEPT
AT 2400 BYBERRY RD OR EMAILED TO permitcenter@bensalempa.gov
ALL PLANS PREPARED BY A DESIGN PROFESSIONAL MUST BE SUBMITTED ELECTRONICALLY
VIA DISC OR EMAIL – NO PAPER PLANS ACCEPTED
County:
BUCKS
Municipality:
BENSALEM
Application Date:
Approval Date:
PERMIT NUMBER:
Bensalem Permit #
BUILDING
SECTION:
ESTIMATED COST
OF
BUILDING WORK (Contract V
alue)
$
_______________


Number of Residential Units: ________________ Existing _________________ Proposed
Type of Structural Frame:
Wood Masonry Concrete Pre-Manufactured Dwelling
Steel Other, Explain: ______________________________________
Does or will your building contain any of the following:
Elevators/Excalators/Lifts/Moving Walks:
YES NO Pressure Vessels: YES NO
Sprinkler System:
YES NO Refrigeration Systems: YES NO
Fireplace(s): Number _____________ Type of Fuel ____________________ Type of Vent ______________________
Bedrooms (number
)
Stories
(number)
Street Frontage
(
feet
)
Full Baths
(number)
Building Area
(
sq/ft
)
F
r
ont Setback
(
feet
)
Partia
l
B a t h s
(number)
Living Area
(
sq/ft
)
Rea
r
Setback
(
feet
)
Garages (number)
Basement Area (sq/ft) Left Setback
(
f
eet)
Garage Area
(sq
/
ft
)
Offic
e
/Sales
(
sq/ft
)
Right Setback
(
feet
)
Outside Parking
(numbe
)
Service
(
sq/ft
)
Height Above Grade
(
fe
e
t
)
PLUMBING
SECTION:
ESTIMATED COST
OF
PLUMBING WORK (Contract V
alue)
$___________
NEW PLUMBING WORK REQUIRES AUTHORIZATION FROM BUCKS COUNTY WATER & SEWER AUTHORITY
Enter the number and size of Fixtures being
Repaired
,
Replaced or Instal
l
ed
  
MECHANICAL
SECTION:
ESTIMATED
COST OF
MECHANICAL WORK (Contract
Value)
$__________
Enter the number and size of Units being Replaced or
I
n
stalled
Forced
Air
Furnace
Space Heater
A/C
Compressor
Solid fuel Aj)
liance
Unit
Heater
Split
AJC
Unit
Heat
Pump
Boiler
Coil
Unit
Air
Handling
Un
it
Gravity Furnace
Gas/Oil Conversion
Electric Furnace
Incinerator
Air
Cleaner
Other:
Fuel Type:
Gas
Oil
L.P.
Electric
Coal
Wood
Other
ELECTRICAL
SECTION:
ESTIMATED
COST OF
ELECTRICAL WORK (Contract Value)
$
__________
Enter the number and size of Fixtures being
Repaired
,
Replaced or Installed
Service Amps # of Circuits _________ # of Service Outlets ___________ 110V ______ 220V _______ Utility #
List devices
Qty
Load/Output List devices Qty Load/Output List devices
Qty Load/Output
Switch
e
s
Dishwasher
Heate
r
Recepta
c
les
·

Washer
Hot Water Heater
Circuit
Pan
el
Dryer
Lights
Spa
I
Hot Tub
Smoke Det.

A/C
Unit
FIRE
PROTECTIO
N
SECTION
:
ESTIMATE
D
COST
OF
FIRE
PROTECTIO
N
WORK
(Co
ntr
act
value
)
$_________
Enter the number and
si
ze
of Equipment being
Replaced
or Installed
Sprinkler System
Hood Suppression System
Fire Alarm
System
Stand
Pi
p
e
Fire
H
y
drants
Smoke
Control S
y
stem
Su
pp
ression S
y
stem
Fire
Pum
p
s
Fire
Detection System
Other
:
Rev 3/2016 P
age2of4
Tubs I Showers

Laundry Tubs Sewage Ejectors
Shower stalls
Dishwashers
Back Flow Preventers
La
v
atories

Garbage Disposals Water Pum
p
s
Toilets Wate
r
Heaters Wate
r
Service
Urina
ls
Wate
r
Softeners Sewe
r
Connection
Sinks

Other
Water Service: (Check)
Public
Private
Sewer Service: (Check)
Public
Private - Septic Permit #
IS PLUMBING WORK NEW?
YES
NO
Text
Revised February
20
1
0
Is the site located within an identified flood hazard
area?
Y
ES
NO
Will any portion of the flood hazard area be
developed?
YES
NO

FLOODPLAIN
:
Owner/Agent shall verify that any proposed construction and/or development activity complies with the
requ
i
rement
s
of the
National Flood Insurance Program and the Pennsylvania Flood Plain Management Act (Act 166-1978), specifically Section
60
.3
Lowest Floor
Le
v
el
:
______________
HISTORIC DISTRICT:
Is the site locate
d
within a Histo
r
i
c
District?
YES
NO
If
construction
is proposed within a Historic District, a certificate of
appropriateness
may be required by the
Municipalit
y
.
The applicant certifies that all information on
this application is
correct and the work will be completed
i
n
accordance
with the
approved
c
on
s
tm
c
ti
o
n
d
ocuments and PA
Ac
t
45
(U
niform
C
o
n
s
truct
ion Code) and
a
ny add itional approved
bui
l
d
ing code requirements
adopted by
the
M
unicipality.
T
h
e
property
owner
a
nd
a
p
p
l
icant
a
s
s
ume
s
t
h
e
r
e
s
p
o
n
s
ibilit
y
of locating aU property lines, setback lines,
easements, rights-of
way, flood
a
reas, etc.
I
ss
ua
n
ce
of a pennit and
a
pproval of
constmction documents shall
not
b
e
construed as authority to v
i
o
la
te
,
cancel or set
aside
any
pr
o
vi
s
i
o
n
s
of
the
codes or ord inances of the Municipal ity
or a
n
y other governin g body. The applicant
certifies
he/s
h
e
understands
all the applicable
codes,
ordinances and
r
e
g
u
l
a
ti
o
n
s.
A
pplication
for a permit
s
h
all
be
made by the owner or lessee of the
building
or
s
tru
c
t
u
re, or agent
o
f
e
i
th
e
r
,
or by the
registered
design professional
e
mpl
oye
d
in connect
i
on
with
the
proposed
wo
r
k.
Certificate
of
occupancy.
§
403.46(a)
A building,
s
tr
u cture or
fac
ili
ty may not be used or occupied without a certifica
te
of occupancy issued by a building
code
o
ff
i
c
i
a
l.
§
403
.
46(d)
A building
code
official may
suspend
or revoke a certificate of occupancy
w
hen
the
certi
ficate was
issued in error, on the
b
a
s
i
s
of
incorrect
i
nformation
supplied
by the pennit applicant or in violation of the
Uniform
Construction Code.
Before
a certificate of
occupancy
is
r
evoke
d
,
a
b
u
i
l
di
n
g
owner may
r
e
qu
es
t
a
hearing before t
h
e
board of
ap
p
e
a
l
s
unde
403
.
1
22
(
r
e
la
ting to appeals, v
a
ri
a
nces and
ex
t
e
n
s
i
o
n
s
o
ftim
e).
I
certif
y
that the
code administrator or
the
code
administrato
r
'
s
authorized representative shall
have the
authority
to
enter areas
covered
by
such permit
at any
reasonable hour
to
enforce
the
provisions
of the
code(s) applicable
to such permit.
Signature of Owner or Authorized Agent Print Name of Owner or Authorized
Agent
Address
Date
Directions to
Site
:
************"'***************"'
(
FOR
ADMINISTRATIVE
USE ONLY
)**
*********************
********
ADDITIONAL PERMITS/APPROVALS REQUIRED
STREETCUT/DRIVEWAY
YES
NO
ONFILE ONLOTSEPTIC
YES
NO
ONFILE
CUTANDFILL
YES
NO
ONFILE ZONING
YES
NO
ONFILE
PENNDOTHIGHWAYOCCUPANCY
YES
NO
ONFILE HARB
YES
NO
ONFILE
DEPFLOODWAYORFLOODPLAIN
YES
NO
ONFILE OTHER
YES
NO
ONFILE
SEWERCONNECTION
YES
NO
ONFILE OTHER
YES
NO
ONFILE
APPROVALS
BUILDING PERMIT DENIED
YESNO
D
A
TE
:
DATE RETURNED:
ISSUED BY:
TOTAL SQ FT USED FOR FEE
S
q
Ft
TOTAL CONTRACT VALUE USED FOR FEE
$
PLAN PERMIT
FEE
$
FIRE PERMIT
FEE
$
BUILDING PERMIT
FEE
$
ACCESSIBILITY PERMIT
FEE
$
ELECTRIC PERMIT
FEE
$
ENERGY PERMIT FEES
$
PLUMBING PERMIT FEE
$
ADMINISTRATIVE FEES
$
MECHANICAL PERMIT
FEE
$
STATE
FEES
$
TOTAL CONSTRUCTION PERMIT FEES:
$
Page 3 of
4
Residential Permit Application and Submittal Requirements
The following sections located on page one must be completed in full :
I. County and Municipality
2. Location of proposed work or improvement, most importantly, site location, tax parcel number and lot number.
3. Type of improvement including a brief description of work.
4. Owner information with complete mailing address.
5. Estimated cost of construction is required to be provided.
The contactor section is required to be completed only
when work is performed within Municipalities that require contractor registration. However,
Code
Inspections, Inc. requests a minimum of the primary contractor information to be provided in case correspondence or contact is
necessary.
Page two needs to be completed for only the sections that apply to the proposed project, or work to be
performed.
Page three needs to be completed for floodplain information and, a signature by the property owner, or agent of the owner must be provided on
page
three. The bottom of page three is intended for administrative use and will be completed by Code Inspections, lnc. during the application
review.
PLANS AND
SUBMITTALS
The submittal shall include one complete set of plans, a plot plan and specification sufficient to indicate the scope of work being proposed. Listed
below
are some basic examples of information necessary to complete a plan review. Additional information may be requested depending on
the
intended project. Any document larger than 11 x 17 must be submitted in electronic format (disc, email,
etc.)
• Project design shall conform to the most current edition of the International Residential Code adopted by the Commonwealth of
Pennsylvania.
Drawings shall specify all site information such as address, lot number, TMP number, owner name and type of work Proposed. This
information
shall be reflected on all
pages.
Drawings shall include Floor plan showing new construction in comparison to existing, room labels or use of rooms, bearing locations,
window
and door sizes, header sizes and all other pertinent information. Footing details and specifications shall be provided for all locations. Detail
should
include a footprint or outline of the scope of work as well as specifying pier or continuous footings where applicable. Pre-cast concrete panels
and
all other pre-manufactured products shall have manufacturers engineered designs and
specs.
• Insulation and thermal values shall be indicated for walls, ceiling, floors, basement walls and slab
perimeter.
Indicate electrical components including locations and
sizes.
Swimming
Pools
• Provide swimming pools construction
specifications.
• Swimming pool enclosures and barriers shall be shown and include fence, gate and gate device
details.
Commercial Permit Application and Submittal
Requirements
The Application shall be completed as explained in the Residential information listed above.
PLANS AND SUBMITTIALS
The submittal shall include one complete set of plans and specifications bearing the signature and seal of a licensed Design Professional. Plans
and specifications shall, at minimum, be required to contain the information specified within the sections listed below.
§ 403.42a(b) A permit applicant shall submit an application to the building code official and attach construction documents, including plans and
specifications, and information concerning special inspection and structural observation programs, Department of Transportation highway access
permits and other data required by the building code official with the permit application. The applicant shall submit three sets of documents.
§ 403.42a(c) A licensed architect or licensed professional engineer shall prepare the construction documents under the Architects Licensure
Law (63 P. S. §§ 34.1-34.22), or the Engineer, Land Surveyor and Geologist Registration Law (63 P. S. §§ 148-) 58.2). An unlicensed
person
may
prepare design documents for the remodeling or alteration of a building if there is no compensation and the remodeling or alteration
does not relate to additions to the building or changes to the building's structure or means of egress.
§ 403.42a(e) The permit applicant shall submit construction documents in a format approved by the building code official. Construction documents shall
be clear, indicate the location, nature and extent of the work proposed, and show in detail that the work will conform to the Uniform Construction Code.
§ 403.42a(1) All of the following fire egress and occupancy requirements apply to construction documents:
§ 403.42a(1)(I) The permit applicant shall submit construction documents that show in sufficient detail the location, construction, size and charac
ter of all
portions of the means of egress in compliance with the Uniform Construction Code.
§ 403.42a(f)(2) The construction documents for occupancies other than Groups R-2 and R-3 shall contain designation of the number of occupants to be
accommodated on every floor and in all rooms and spaces.
§ 403.42a(f)(3) The permit applicant shall submit shop drawings for a fire protection system that indicates conformance with the Uniform Construction
Code in accordance with the following: .
§ 403.42a(f)(3)i. The shop drawings shall be approved by the building code official before the start of the system installation.
§ 403.42a(f)(3)ii
The shop drawings must contain the information required by the referenced installation standards contained in the " International
Building Code."
§ 403.42a(g) Construction documents shall contain the following information related to the exterior wall envelope:
§ 403.42a(g)(I) Description of the exterior wall envelope indicating compliance with the Uniform Construction Code.
§ 403.42a(g)(I) Flashing details.
§ 403.42a(g)(1) Details relating to intersections with dissimilar materials, corners, end details, control joints, intersections at roof, eaves, or parapets,
means of drainage, water-resistive membrane and details around openings.
§ 403.42a(h) Construction
documents shall contain a site plan that is drawn to scale. The building code official may waive or modify the following site
plan requirements if the permit application is for an alteration or repair or if waiver or modification is warranted. Site plan requirements include all of the
following:
§ 403.42a(h)(1) The size and location of new construction and existing structures on the site.
§ 403.42a(h)(2) Accurate boundary lines.
§ 403.42a(b)(3) Distances from lot lines.
§ 403.42a(b)(4) The established street grades and the proposed finished grades.
§ 403.42a(h)(5) If the construction involves demolition, the site plan shall indicate construc
tion that is to be demolished and the size and location of
existing structures and construction that will remain on the site or plot.
§ 403.42a(h)(6) Location of parking spaces, accessible routes, public transportation stops and other required accessibility features.
§ 403.42a(l) A building code official may waive or modify the submission of construction documents, that are not required to be prepared by a licensed
architect or engineer, or other data if the nature of the work applied for does not require review of construction documents or other data to obtain
compliance with the Uniform Construction Code. The building code official may not waive
the submission of site plans that relate to accessibility
requirements.
§ 403.42a(m) An applicant for an annual permit under § 403.42(f) shall complete an application and provide information regarding the system that may
be altered and the date that approval was previously provided for the approved electrical, gas, mechanical or plumbing installation.
§ 403.42a(n) A permit applicant shall comply with the permit, certification or licensure requirements of the following laws applicable to the construction:
§ 403.42a(n)(I) The Boiler and Unfired Pressure Vessel Law (35 P. S. §§ 1331 .1- 1331 .19).
§ 403.42a(n)(2) The Propane and Liquefied Petroleum Gas Act (35P. S. §§ 1329.1 - 1329.19).
§ 403.42a(0)(3) The Health Care Facilities Act.
§ 403.42a(0)(4) The Older Adult Daily Living Centers Licensing Act
Rev 3/2016 Page 4 of 4
INFORMATION SHEET
ONLY NOT REQUIRED TO
SUBMIT THIS SHEET
WITH PERMIT
APPLICATION
INFORMATION SHEET
ONLY NOT REQUIRED TO
SUBMIT THIS SHEET
WITH PERMIT
APPLICATION
INFORMATION SHEET
ONLY NOT REQUIRED TO
SUBMIT THIS SHEET
WITH PERMIT
APPLICATION
INFORMATION SHEET
ONLY NOT REQUIRED TO
SUBMIT THIS SHEET
WITH PERMIT
APPLICATION
INFORMATION SHEET
ONLY NOT REQUIRED
TO SUBMIT THIS
SHEET WITH PERMIT
APPLICATION
INFORMATION SHEET
ONLY NOT REQUIRED TO
SUBMIT THIS SHEET
WITH PERMIT
APPLICATION
INFORMATION SHEET
ONLY NOT REQUIRED TO
SUBMIT THIS SHEET
WITH PERMIT
APPLICATION